This project focuses on oral changes associated with HIV-1 infection. We have examined saliva, a critical part of the oral defense system, for changes following infection. Salivary secretions from HIV-1 positive patients with salivary gland enlargement (HIV-SGD) which mimics that seen in Sjogren's syndrome were analyzed. Higher elevations of salivary IgA, lactoferrin, and IgA rheumatoid factor (RF) were present in HIV-1 positive patients with salivary gland enlargement than in HIV-1 positive patients with no enlargement. However, the saliva from patients with primary Sjogren's syndrome had much higher levels of salivary IgA, lactoferrin, and IgA RF. Forty-four percent of patients with HIV-SGD also had salivary autoantibodies that recognized the cytoplasm of a salivary epithelial cell line, but the autoantibodies were not anti-SS-A, anti-SS-B, or anti-DNA. In contrast, 73% of patients with primary Sjogren's syndrome had anti-SS-A or anti-SS-B. Periodontal status in approximately 200 HIV-1 seropositive patients was assessed (see Z01-DE-000498-02). HIV-associated periodontitis was not found, and HIV-associated gingivitis was more common. Preliminary data suggest no uncommon pathogens are associated with HIV-gingivitis. HIV-1 proviral sequences were found in 50% of whole saliva samples from HIV-1 seropositive patients (see Z01 DE-00423-06). Though it appears that HIV-1 is not spread through a salivary route, the finding suggests an infectious potential for saliva. The oral manifestations of pediatric patients with HIV-1 infection are currently being studied.